This study reports the role of surgery and laser approach in management children kaposiform hemangioendothelioma.
A 5 -year (2009-2014) retrospective study on the challenges and outcome of two hundred forty five children with vascular anomalies referred for surgical management was undertaken at the Tashkent Medical Academy, Uzbekistan. After multidisciplinary discussion, all patients underwent photodynamic therapy under general anesthesia, with 5-ALA as the photosensitising agent.
In a time of treatment by eighty five out one hundred eight patients who presented with long-term pain reported improvement after treatment. Also, 43/46 reported significant reduction of bleeding related to their vascular anomaly. Improvement of swelling was reported by 189/199 patients; while reduction of infection episodes was evident in 61/63 patients and 176/205 reported reduction in the disfigurement caused by their pathology. Clinical assessment showed that more than half of the patients had 'good response' to the treatment. Significant clinical response was reported by 148 (60,4%) patients, moderate result by 70 (28,6%). Radiological and ultrasound assessment comparing imaging 6-week post-laser and PDT to the baseline showed moderate response in 78 (31,8%) patients and significant response in 122 (49,8%) patients.
The management of kaposiform hemangioendothelioma continues to be extremely challenging. Although several modalities have been developed and the literature reports successful treatment in many, data from long term studies reports relapse in many and the need for re-treatment or another intervention. Photodynamic therapy is not superior to other modalities, but it is characterised by being one of the least invasive, being repeatable with no residual toxicity and with a minimal bystander effect on the overall tissue architect and integrity as well as nerves. The growing body of evidence regarding its efficacy, the increasing use of image guided PDT, and the innate minimally invasive characteristics of PDT suggest that it should become an important addition to the various techniques used in the management of kaposiform hemangioendothelioma.
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All authors have declared no conflicts of interest.